Hospital Safety Inspection Form
Please fill out the form to report the safety inspection details.
Inspector Name
First Name
Last Name
Inspection Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Department/Area Inspected
Safety Equipment Condition
Good
Fair
Poor
Cleanliness and Hygiene
Satisfactory
Needs Improvement
Unsatisfactory
Fire Safety Measures
Compliant
Non-compliant
Not Applicable
Emergency Exits Accessibility
Accessible
Blocked
Not Applicable
Comments and Recommendations
Submit
Should be Empty: